evaluación de la broncodilatación dr. hernando sala hospital nacional a posadas el palomar -...
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Evaluación de la broncodilataciónDr. Hernando SalaHospital Nacional A PosadasEl Palomar - Argentina
Saltos del MoconáRío Uruguay - MisionesArgentina
Curvas flujo-volumen máximos en un paciente asmático antes (línea llena) y después (línea discontinua) de la administración de un broncodilatador
Evaluación de la Broncodilatación
Diagrama esquemático del efecto agudo causado por la inhalación de un broncodilatador, en un paciente con asma de gravedad variable. La mejoría de FEV1 (línea discontinua) suele ser mayor cuando su valorar pre-broncodilatador está moderadamente reducido.
Relación entre FEV1 y la respuesta bronquial a la metacolina (PC20 mg ml –1) en pacientes con EPOC
CHANGES IN RESIDUAL AIR VOLUME AFTER THE USE OF BRONCHODILATOR AGENTS
KANAZIRSKI P, TSANEV B, BACHVAROV L.Probl Tuberk. 1963;41:77-81.
Olive and Hyatt 1978
Broncodilatación y DLCO
Effect of bronchodilatation on single breath pulmonary uptake of carbon monoxide in chronic obstructive pulmonary disease.
Baldi S, Fracchia C, Bruschi C, Dore R, Maestri R, Brusasco V, Pellegrino R.Int J Chron Obstruct Pulmon Dis. 2006;1(4):477-83.
Bronchoconstrictor effects of a deep inspiration in patients with asthma.Gayrard P, Orehek J, Grimaud C, CHarpin J.Am Rev Respir Dis. 1975 Apr;111(4):433-9.
• A deep inspiration from functional residual capacity to total lung capacity, performed at a low flow rate by a group of 40 unselected adult patients with asthma, yielded an immediate and transient increase (71 per cent, P smaller than 0.001) in specific airway resistance. In 2 of the 40, deep inspiration provoked an attack of asthma. The effect of deep inspiration can be attributed to a vagal bronchoconstrictor reflex, because it was prevented or decreased in most of the cases by inhalation of an anticholinergic drug. Beta-adrenergic blockade by propranolol potentiated in a minority of subjects the bronchoconstrictor response to deep inspiration. Deep expiration also induced a bronchoconstrictor effect, which was weaker than that of deep inspiration. It follows that functional studies of asthmatics may be biased if the technique requires maximal respiratory maneuvers.
Curvas V/V Parciales
Reversibility of the pulmonary function based on the partial flow-volume curve predicts the efficacy of bronchodilator therapy for treating chronic cough.
Nakade Y1, Fujimura M, Ohkura N, Nakata M, Nanbu Y, Oe H, Horita H, Sakai Y, Wada T.Intern Med. 2013;52(18):2017-23.
OBJECTIVE:Partial expiratory flow-volume curves have the potential to detect mild bronchoconstriction because they are not affected
by the modulatory effects of deep inspiration. The aim of this study was to investigate the relationship between the efficacy of bronchodilator therapy (BDT) in treating the cough and to assess the increase in the expiratory flow of the partial flow-volume curve at 40% above the residual volume level (PEF40) caused by treatment with a short-acting beta-2 agonist (SABA) in patients with chronic nonproductive cough.
METHODS:We measured the reversibility of PEF40 caused by a SABA in 42 patients with chronic nonproductive cough at visit 1 (day
0). The patients received BDT for six days. The visual analogue scale (VAS) was used to assess the efficacy of BDT in treating coughing at visit 2 (day 7) (0 mm, 'no cough;' 100 mm, 'no change in coughing').
RESULTS:Reversibility of the PEF40 was correlated (r=0.690, p<0.001) with the VAS score determined at visit 2 and was higher in the
patients with cough variant asthma (CVA) (44.9 ± 18.3%) than in those with atopic cough (13.4 ± 10.4%) (p<0.01).CONCLUSION:Reversibility of the PEF40 predicted the efficacy of BDT in patients with chronic nonproductive cough and helped to
identify patients with CVA.
• Airways flow resistance as a measure of the efficacy of inhalants in clinical drug trials.
• Cohen BM.• Helv Med Acta. 1969 Mar;34(6):455-67.
.
Forced oscillation technique vs spirometry to assess bronchodilatation in patients with asthma and COPD.Zerah F, et alChest. 1995 Jul;108(1):41-7
We conclude that the use of FOT can be considered as an alternative to forced expiration for detecting bronchodilatation in asthmatics and patients with COPD.
• Sensitivity of impulse oscillometry and spirometry in beta-blocker induced bronchoconstriction and beta-agonist bronchodilatation in asthma.
Short PM, Williamson PA, Lipworth BJ.
Ann Allergy Asthma Immunol. 2012 Dec;109(6):412-5.
Impulse oscillometry: interpretation and practical applications.Bickel S, Popler J, Lesnick B, Eid N.Chest. 2014 Sep 1;146(3):841-7.
FOT La mejor manera de medir la broncodilatación en población pediátrica
Monaldi Arch Chest Dis, 2001; 56:6, 555-582
Diagrama del diseño de un equipo para medir resistencia
Caja de madera
Circuito
Parlante
Malla
Tubo flexible
Transductores de presión
Neumotacógrafo Pieza bucal
Polígrafo
Amplificadores Convertidor A/D
PC
Transductor de presión Generador de
señal
Neumotac
Tubo flexible
Parlante
Caja
Señal de presión registrada en la boca
Señal de flujo
Presión
Flujo
Impedancia calculada
Monaldi Arch Chest Dis, 2001; 56:6, 555-582
R =Delta P/V
A partir del estudio de las presiones resultantes que se encuentran en fase y fuera de fase en relación con la señal se pueden calcular tanto la resistencia como la reactancia.
Inertancia
Elastancia
Resistencia
Reactancia
0
Impedancia del sistema respiratorio: es la suma de la resistencia y la reactancia
Zx = Rrs + Xrs
La reactancia es la suma de la elastanciay la inertancia, en electricidad capacitancia e inductancia respectivamente.
Xrs = XC + XL
Impedancia
Forced Oscillation Technique (FOT)
Aplicaciones Clínicas
Pruebas de broncodilatacióny broncoconstricción
No necesita inspiraciónprofunda ni espiraciónforzada
Meseta de SomuncuráPatagonia
Muchas Gracias
Inertancia
Elastancia
Resistencia
(Reactancia)
Frecuencia de resonancia
Los cambios de presión dependen solo de la resistencia
Impedancia
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